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_ vrt vrm- [ Ute: 1 ; APPLICATION FOR SANITATION PERMIT Permit No. ....1._ 3 _... --- ----------- - ------------ ------------- ----------- (Complete in Duplicate) �C/�prj�,r ---------- ----------- This Permit Expires I Year Frorl Date IssuedA��rCDDate Issued .___ 6. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. M`Tcq - JOB ADDRESS AND LOCATION_bf--S:IDr !7_I } _P_�.'_'1-�--`--'-_ V------BALL?----C� ----- JL -------- x" `, Owner's Name------------6A P-L e-�--•------� !��r --- ---•- - - -- - P C IAddress--------- -•`---� ` -UQx-------14 --------- . ' ---------••-------•-------••-----• --------- Contractor's Name__,C11R&1-!t f Phone Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ j Number of living units: --1_.. Number of bedrooms _3-- Number of baths /_.._ Lot size ________________________ I Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table Zs—ft. Character of soil to a depth of 3 feet: Sand (Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: {If yes,date____________________) NoAn-�New Construction: Yes Rr No ❑ FHA/VA: Yes ❑ No 2�` i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) p e from nearest well_._SO----_Dista e from foundation___l�-_-----_-Mater•al__�. VIVO—R T�__________- { Septic Tank: Distant r No. of compartments._._._______.__..Sizel ! 1.17`,'"x-___Liquid depth___��—_____capacity___j_ .��_____ Disposal Field: Distance from nearest well.--.,S- Distance Distance from foundation------ a___._ .Distance to nearest lot line__ __________ E ©� Number of lines----------_0�_____________Length of each line___5Q__.s--4A0-__.Width of trench...... ``__.___________.___ --_Depth of filter material____- _ __________:Total length.----.-- i ------ _______________ Type of filter material__ __ .Q_G� p _� - Seepage Pit: Distance to nearest well------_---------------Distarice from foundation--------------------Distance to nearest lot line-----------------" ❑ Number of pits----------------------Lining material----------"------------Size: Diameter------_'--------------Dept h--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------__----- Lining material-_._._._____.______._.________..__. ❑ Size: Diameter-------------------------------------Depth---------- ----------------------------------------Liquid Capacity.-- ------------------------gals. Priv Distance from nearest well-------- '"Distance from nearest building----------------------------______________ ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):--------------------------------- ------------------------------------------------------------------------------------------------------------------------ ---------------------------- ------------------------------------------- ------------------- ---------------------------------------------------------------------------------`---------------------••-•--•------------------------------------------------------------------------------------------------------- __________________________________________ - 4 ________ ______________ _______ ___________________________________________________________________________________________________________________________________ _ I hereby certify that I have prepared this application and that the work" ill1" done in accordance with San Joaquin County ordinances, State laws, and rules and regulations.of the'San Joaquin local Health District. t {Signed) ..� :_ .fit.=? .2 G "� �✓ -------- ---- ------- and/or_-- -= '- -- __-. . .___-- _ ____-- ____-- r Contractor caner B ----- - - Title -- ----- --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). -�-- p FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- _..1 [1_ Q'- ---- - ------ ----- ---------------------------------------------- DATE----- ---7 2 .'"+r'S ------- REVIEWEDBY--------------------------- -------------------------------------------------------------------------------------------------- DATE----------------------------------------------- ----- BUILDING PERMIT ISSUER-------------------------------------- ------------------------------------------------ DATE-------- --------------------------------------------------- Alterations and/or recommendations-------------- ------"--------------- --- -- - ---------------------------------•---------•----------•--------•------------------------•----------------- ------------------------------------------------------------------------------------------------------------ ----•---.------------------------------------------------------------------------------------------------------- FINAL INSPECTI Z� = Date _/ ----------- --"---- -•-5 - ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.HazeltonAve. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy, California